A digest of events, trends, issues, ideas and journalism from and about rural America, by the Institute for Rural Journalism and Community Issues, based at the University of Kentucky.
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Thursday, October 18, 2018

Why scientists aren't sure how many people abuse opioids: They don't ask the right questions, or the same ones

The opioid epidemic is an undeniable public-health crisis, but it's hard to estimate how many people are misusing narcotics or dying from overdoses, Joseph Palamar writes for The Conversation. Palamar is an associate professor of population health at New York University.

Though overdose and death data are fairly reliable, researchers are struggling to understand more about opioid misuse that doesn't leave a paper trail from a hospital visit or death. Drug surveys are the main method of collecting such data, but they're often inaccurate because many respondents underreport or overreport opioid use; sometimes that's because they're lying, but sometimes it's because they don't understand what the survey is asking, Palamar reports.

Palamar, who has done survey research about drugs for almost 20 years, writes that there is no easy answer to finding more accurate information with such surveys, but believes researchers will get better results if they ensure that respondents understand the survey questions. "On surveys, opioid misuse is sometimes defined as using without one’s doctor telling you to do so. Other times, it’s defined as using without a prescription. The most accurate definition is use not directed by a doctor, including using opioids without a prescription or using greater amounts, or more often or longer than directed," Palamar reports. "It’s important to include definitions of opioids and misuse on surveys. However, such definitions are meaningless if those taking the survey refuse to read them."

Some respondents may be unfamiliar with the terms "opioids" or "narcotics" or may not know which drugs are considered opioids and which aren't. "For example, my colleagues and I discovered that a over a third of high school seniors who reported nonmedical Vicodin or OxyContin use denied using opioids nonmedically overall. This suggests many users may be unaware that these drugs are opioids." Respondents may also be confused by similar drug names like methamphetamine and methadone, and it's important for researchers to make sure respondents understand survey questions, since the answers results inform further research, prevention, harm reduction and policymaking, Palamar writes.

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